Search

Background: Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia since 2001. At present, four studies on antipsychotics in schizophrenia, two antidepressants, one bipolar disorder and one mood disorder were completed. Previous studies have examined the use of Long-acting Injectable (LAI) antipsychotic in patients with schizophrenia and revealed major differences across countries. The aim of the study is to investigate the prescription trend of LAI antipsychotic use in four REAP schizophrenia surveys. Methods: We analyzed the results from four times of REAP studies (AP1 to AP4, 2001, 2004, 2009 and 2016), to compare the trend of LAI prescriptions rates in China, Hong Kong, Japan, Korea, Singapore, and Taiwan, and also the rate of LAI use among 15 Asian countries in AP4. Results: A total of 10505 patients were analyzed, with an average rate of 14.6% of patients received LAI antipsychotic treatment. For comparison of AP1 to AP4, there was a wide variation in the rate of LAI use among the six countries, with the highest prescription rate in Singapore (68.1%) and the lowest in Korea (1.6 %). Korean patients received no LAIs treatment in the first two surveys, and the rates in China and Japan were also very low. While in Hong Kong and Singapore, the rates were much higher. In AP4 survey, India, Malaysia, Thailand, Pakistan and Sri Lanka have a higher rate of LAI use, while in Indonesia, Myanmar, the rate is much lower. Vietnam does not use LAI at all. The prescription trend was also diverse, which increased in Korea and Japan and decreased in China, Hong Kong and Singapore. The overall prescription trend of LAI was in decrease. Besides, when analyzing cases with only using second generation antipsychotics, the usage of LAI was increased. Discussion: Previous studies identified several factors associated with prescription of LAI, including demographic and clinical characteristics of patients, patients’ and physicians’ attitude towards LAI, availability of LAI, insurance coverage and related cultural factors. The prescription trend of first generation LAI was decreased in most of the six countries; on the other hand, second generation LAI usages maintain steady level and even slightly increased. In conclusion, LAI antipsychotic is still underuse in Asia, especially in some countries such as Korea, China, Japan, Indonesia and Myanmar. Various factors that influenced the prescription rate of LAI antipsychotic should be addressed further. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Substance use disorders are familial, and genetic factors explain a substantial degree of their familial aggregation. This study employs an association approach to examine the genetic underpinning of methamphetamine (MAMP) use and MAMP-induced psychosis. METHODS: A total of 416 MAMP abusers from a hospital and a detention center in Taipei were interviewed with the Diagnostic Interview for Genetic Study and the Family Interview for Genetic Study. Genetic polymorphisms of D2-like dopamine receptor genes, DRD2 TaqI A, DRD3 Ser-9-Gly, and DRD4 exon III variable number of tandem repeats, were compared between: (a) MAMP users as a whole and 435 normal controls, and (b) those 154 individuals with MAMP-induced psychosis and the 252 MAMP users with no psychosis. RESULTS: None of the three markers we studied were associated with predisposition to psychosis among the MAMP abusers. The MAMP abusers had a higher (P=0.011) prevalence of the seven-repeat allele of DRD4 than normal controls. CONCLUSIONS: Chance fluctuations in the frequency of rare alleles and ascertainment differences in the case and control samples cannot be ruled out. Therefore, further studies of the seven-repeat allele in MAMP abusers and controls should be performed before an association can be established. [ABSTRACT FROM AUTHOR]

Objective: In this study, we intended to evaluate the effectiveness and safety of switching to lurasidone in patients with schizophrenia and to get clinical experiences of real-world practice in those who showed suboptimal therapeutic effect and/or intolerability to lurasidone in Taiwan. Methods: We enrolled adult patients (aged 20–75 years) with schizophrenia who had been receiving antipsychotic medications but still continued to show mild-to-moderate symptoms or intolerability, for switching switch to an open-label lurasidone 40–160 mg daily for six weeks. The primary end point of the study was to assess the time to treatment failure, defined as any occurrence of insufficient clinical response, worsen underlying symptoms, or discontinuation due to adverse events. Secondary efficacy measures of the study included decreased scores in the positive and negative syndrome scale (PANSS) total and the clinical global impression-severity scale.(CGI-S), as well as increased clinical global impression-improvement scale (CGI-I). Safety measures included occurrences of treatment-emergent adverse events (TEAEs), abnormal vital signs, Electrocardiogram (ECG), and laboratory parameters. Results: We enrolled 54 patients with 51 completing the study. One patient terminated early due to adverse events and two patients had insufficient therapeutic efficacy. Mean ± standard deviation (SD) time to treatment failure was 27.7 ± 13.1 days. Mean ± SD changes from baseline to six weeks on PANSS, CGI-S, and were −16.8 ± 14.4, −0.6 ± 0.59, and −1.1 ± 1.0, respectively . The most common TEAE was hyperprolactinemia. Furthermore, body weight was significantly decreased from baseline to the end of the study by 0.83 ± 1.96 kg (p < 0.01). Mean ± SD blood prolactin level also was significantly decreased from baseline to week 6 (48.7 ± 52.8 ng/dL vs. 23.9 ± 57.8 ng/dL, p < 0.001). Conclusion: After switching from another antipsychotic, patients with schizophrenia treated with lurasidone showed a low rate of treatment failure among patients in Taiwan. The safety profile is similar to that in previous published lurasidone studies.

Research in East Asia Psychotropic Prescription Pattern (REAP) is Asia's most extensive and lengthiest international collaborative research on psychiatry. The Research in East Asia Psychotropic Prescription Pattern on Antidepressants (REAP-AD) conducted international collaborative surveys on patients prescribed antidepressants since 2003. The REAP-AD study was initiated in three series: the REAP-AD, REAP-AD2 and REAP-AD3. The main objectives of REAPAD are to study the symptom profile variations of depressive illness and the prescription pattern of antidepressants in the participating Eastern and Southern Asia countries using a unified research protocol. To date, Malaysia has contributed the research survey data in the REAP-AD2 and REAP-AD3 studies. The REAP-AD2 study revealed that with depressive symptoms, persistent sadness and insomnia were the two most common presentations of depression in Malaysia. In contrast, guilt and agitation or retardation were the least common. The findings from REAP-AD2 in 2013 showed that Fluvoxamine, Sertraline and Mirtazapine were the top three most prescribed antidepressants. While Fluoxetine, Sertraline and Escitalopram were the most prescribed antidepressants in Asia. Similarly, the REAP-AD2 study revealed that Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and escitalopram, were the most prescribed anti-depressants. The Malaysian data on the antidepressant prescription pattern in the REAP-AD2 study reflects the recommended second-generation antidepressants, particularly SSRIs, as the first and second-line treatment for depression, concurring with the Malaysian Clinical Practice Guideline on Management of Major Depressive Disorder (2007). The REAP-AD3 conducted in 2023 has been expanded to 16 countries as compared to 10 countries in the REAP-AD2 (2013) study and 5 countries in the REAP-AD study (2003/2004). We are embarking on another antidepressant survey in 2023 to compare the changes in the prescribing pattern over the last decade, focusing on the research data reported in Malaysia. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the construct validity (i.e., unidimensionality and convergent validity) and Rasch reliability of the 20-item Comprehensive Occupational Therapy Evaluation Scale (COTES) in people with schizophrenia., Method: Retrospective chart review was used to collect COTES data from 505 inpatients with schizophrenia. For construct validity, we first examined unidimensionality of each of the three COTES subscales using Rasch analysis. After unidimensionality was supported, we examined convergent validity using Pearson's r and Rasch reliability of the individual subscales., Results: After deleting two misfitting items, the remaining items (i.e., the COTES-18) showed unidimensionality. Infit and outfit mean squares were 0.73-1.25. Moderate correlations were found among the three COTES-18 subscales (rs = .57-.71). The Rasch reliabilities of the three subscales were .83-.92., Conclusion: The COTES-18 has sufficient construct validity and reliability to assess three specific dimensions of behavior affecting occupational performance in people with schizophrenia., (Copyright © 2019 by the American Occupational Therapy Association, Inc.)

Background: Cancer is a serious public health problem worldwide, and its relationship with affective disorders is not clear. Aims To investigate alcohol- and tobacco-related cancer risk among patients with affective disorders in a large Taiwanese cohort., Method: Records of newly admitted patients with affective disorders from January 1997 through December 2002 were retrieved from the Psychiatric Inpatient Medical Claims database in Taiwan. Cancers were stratified by site and grouped into tobacco- or alcohol-related cancers. Standardised incidence ratios (SIRs) were calculated to compare the risk of cancer between those with affective disorders and the general population., Results: Some 10 207 patients with bipolar disorder and 9826 with major depression were included. The risk of cancer was higher in patients with major depression (SIR = 2.01, 95% CI 1.85-2.19) than in those with bipolar disorder (SIR 1.39, 95% CI 1.26-1.53). The elevated cancer risk among individuals ever admitted to hospital for affective disorders was more pronounced in tobacco- and/or alcohol-related cancers., Conclusions: Elevated cancer risk was found in patients who had received in-patient care for affective disorders. They require holistic approaches to lifestyle behaviours and associated cancer risks., (Royal College of Psychiatrists.)